*Purpose: The purpose of the present study was to evaluate the safety of adjuvant chemotherapy with gemcitabine plus cisplatin in kidney transplant patients with urothelial carcinoma.

*Methods: A total of 15 kidney transplant patients with urothelial carcinoma were assessed. All patients were treated with surgery and following adjuvant chemotherapy. The chemotherapy regimen was gemcitabine 800 mg/m2 on days 1, 8 and 15 and cisplatin 70 mg/m2 on day 2. A single treatment cycle lasted 28 days. Due to the potential concerted reaction between the immunosuppressant regimen and the chemotherapeutic agents, drug toxicities were closely observed, and a dose reduction of the chemotherapeutic agents was planned.

*Results: Fifteen patients completed a total of 41 cycles. 7 patients completed 2 cycles, 5 patients completed 3 cycles and 3 patients completed 4 cycles. The incidence of hematological toxicities was higher in patients of mycophenolate mofeti. Gastrointestinal reactions were most common in non-hematologic toxicities. Grade 1 nephrotoxicity was found in 5 patients of tacrolimus, and no other grade of nephrotoxicity was observed. The significant predictors of higher grade toxicities were body mass index, age and immunosuppressant regimen.

*Conclusions: Adjuvant chemotherapy can promote overall survival in kidney transplant patients with urothelial carcinoma. Our results suggest the drugs toxicities were acceptable, and body mass index, age, immunosuppressant regimen may be predictors of drugs toxicities.

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